Management of spontaneous rupture of liver tumours

Spontaneous ruptures of a liver tumour are often considered as a potentially life-threatening situation. The aim of the present study was to evaluate both clinical features and treatment in a subgroup of patients with ruptured liver tumours. From 1995 to 2000, 20 patients were referred to our centre for spontaneous rupture of a liver tumour associated with haemoperitoneum. Hepatocellular carcinoma (HCC) was present in 13 patients (11 men and 2 women) aged from 48 to 72 years (mean 62) and adenoma in 7 women aged from 23 to 52 years (mean 35). Although all patients experienced sudden abdominal pain and anaemia, shock at admission was present in 4 (20%) patients including 3 with HCC. In patients with HCC, severe liver insufficiency (Child-Pugh C) was present in 5 cases including the 3 shocked patients. No treatment was undertaken in 2 patients, transarterial embolization was performed in 9 cases and 5 patients underwent delayed resection. In hospital, mortality was observed in 3 (23%) patients, all of them had severe liver insufficiency. Long-term survival was observed in patients with good liver function who underwent resection. In patients with adenoma, shock at admission was observed in only 1 patient under anticoagulation treatment. Emergency resection was performed in 3 cases. A decrease of the tumour size was observed in patients who underwent delayed resection resulting in a lower rate of peri-operative transfusion. In conclusion, this study confirms that the majority of patients with ruptured liver tumours had no evidence of haemodynamic instability and therefore should be initially managed conservatively. In patients with single ruptured HCC associated with good liver function, long-term survival can be observed after liver resection. Delayed resection facilitated the operative procedure in patients with ruptured adenoma.